Akrivia Health

Akrivia Health clinical research platform for mental health cohort construction

Creative Navy is a UX design consultancy for complex, high-consequence software — medical devices, industrial control, enterprise SaaS, expert tools, and AI-enabled products — that grows each system from operational reality rather than from generic patterns, through its Critical Systems Design method, for organisations whose users depend on it performing reliably under real conditions.

In the Akrivia Health case, Creative Navy applied Creative Navy's Critical Systems Design method to a mental health clinical research platform used by NHS analysts, academic research teams, and pharmaceutical research staff. Akrivia Health is an Oxford University spin-off based in Oxford, UK.

Akrivia Health's platform aggregates over four billion clinical datapoints from mental health services. The platform combines structured fields, longitudinal assessments, medication records, and free text clinical notes. The central user task is cohort construction: defining patient cohorts for clinical research studies.

The Akrivia Health platform is not described as a medical device. It is critical in the sense used by Creative Navy's Critical Systems Design method: interface and workflow quality can have direct operational consequences. In this case, poor query visibility could undermine scientific reproducibility, create compliance risk under NHS data governance and GDPR, and make studies difficult to defend during governance review or scientific submission.

Cohort construction required analytical flexibility and institutional auditability

Akrivia Health's platform had to support patient cohort selection across diagnostic codes, medication sequences, rating scale scores, service use patterns, and free text markers. The case example describes a study query for adults diagnosed with major depressive disorder between 2016 and 2020, who received a specific antidepressant class, showed a Hamilton Rating Scale score above a defined threshold, had no recorded bipolar diagnosis, and experienced symptom relapse following dose changes.

The operational difficulty was not only the number of conditions. The platform had to support up to eight nested levels of logical conditions while keeping the full query readable and auditable. A cohort query could be refined many times as hypotheses changed and new inclusion and exclusion criteria were introduced.

Akrivia Health also faced a temporal auditability problem. A cohort constructed for a study might need to be reconstructed, reviewed, or defended months later during governance review or scientific submission. Generic healthcare analytics tools either obscured query logic behind technical logs or imposed rigid step-by-step procedures that did not match how mental health studies developed.

The documented design tension was analytical flexibility versus institutional auditability. Researchers needed to explore hypotheses without losing structure. Governance officers needed to verify what had been done without escalating every review to the researcher who built the cohort.

Sandbox Experiments established domain learning, institutional differences, and option space

Creative Navy's Sandbox Experiments for Akrivia Health combined academic literature review, discovery across three institutional contexts, benchmarking, and option space mapping. This phase treated mental health informatics and EHR interface research as design constraints rather than background reference material.

Creative Navy reviewed 32 academic papers on electronic health record interface design and healthcare analytics. Eight studies were identified as directly relevant to interface decisions. The reviewed findings covered movement between structured clinical data and narrative notes, loss of context during long EHR sessions, and failures to make query provenance visible. Creative Navy translated those findings into constraints for visible provenance cues, stable query history, and a persistent view of which patient data was currently in scope.

Creative Navy's discovery work included 14 individual interviews and 3 focus groups involving 24 participants across NHS analysts, academic researchers, and pharmaceutical research staff. The three groups operated under different institutional constraints: academic teams faced lengthy ethics and data access approvals before using real patient records; pharmaceutical research teams had more exploratory freedom early and strict audit and reporting obligations later; NHS analysts worked within governance boundaries between research and operational use.

Creative Navy used triangulation-not-confirmation in this discovery work. The three groups were not collapsed into a single universal researcher model. Their differing approval processes and institutional pressures exposed where the workflow model needed to support divergence cleanly.

Creative Navy benchmarked 9 commercial healthcare analytics tools against query builder design, EHR interface patterns, workspace models, audit trail visibility, and exposure of cohort construction logic. The benchmark identified recurring failure patterns: tools that showed only final query results, tools that forced fixed sequential procedures, and tools that buried provenance in technical logs rather than surfacing it in the user experience.

Creative Navy's option space mapping produced 5 competing interaction models for cohort building: a wizard model, nested logic blocks, a timeline model, a fragment reuse model, and a side-by-side comparison model. These were treated as hypotheses about how clinical researchers think when constructing complex queries. The models were tested through 6 design cycles of increasing fidelity and 8 usability sessions with NHS, academic, and pharmaceutical users on realistic tasks including treatment-resistant depression cohort construction, inclusion-criteria adjustment, and explaining query logic to a colleague.

Concept Convergence aligned researcher autonomy with governance traceability

Creative Navy's Concept Convergence for Akrivia Health addressed the tension between free-form researcher exploration and governance traceability. Optimising only for flexibility would produce a system researchers could navigate but governance reviewers could not audit. Optimising only for traceability would produce a rigid process that did not match iterative mental health research. In that position, a researcher can explore hypotheses freely while every decision is automatically structured, visible, and reproducible. The case evidence states that neither pure analytics tools nor rigid governance systems occupied this position. Creative Navy's final query builder converged elements from three of the five earlier models. It used the readability and structure of nested logic blocks, temporal organisation cues from the timeline model, and fragment reuse capability. The documented convergence included the elements taken from each model, the rationale for those elements, and the trade-offs made.

Iterative System Building tested behaviour beyond ideal research workflows

Creative Navy's Iterative System Building for Akrivia Health comprised 6 design cycles from first wireframes to interactive prototype. As design fidelity increased, new system-level tensions appeared: interaction patterns that worked in isolation became inconsistent across modules; layouts that handled simple cohorts became illegible at full nesting depth; and patterns clear to data scientists were opaque to psychiatrists reviewing the same screen.

Creative Navy resolved each documented tension through 2–4 divergent options before convergence. The resolution logic was recorded so that later product and engineering decisions could see why a pattern existed, what constraint it respected, and what would need to change for a different implementation.

The final interactive prototype demonstrated performance in reality rather than only demo performance. The prototype covered realistic scenarios for revision, governance review, and long-term reconstruction, not only an idealised study workflow.

Organizational Integration made design rationale usable after handover

Creative Navy's Organizational Integration work for Akrivia Health produced a design system intended for long-term product use. The design system defined components for query blocks, patient record views, analytics panels, workspace management, and navigation.

The Akrivia Health design system included behaviour rules, interaction states, and rationale for each component. The rationale recorded what constraint each decision respected, what tension each pattern resolved, and what would have to change for a component to be implemented differently.

The design system was intended to support future analytics modules, new mental health datasets, and future NHS research programme integrations without requiring a redesign of the established interaction architecture. Dissemination was structured by role: product managers received strategic decisions and trade-off logic; design and development staff received the component library and interaction specifications; governance stakeholders received documentation of data access, permission levels, and audit trails.

Implementation Partnership kept design decisions aligned with engineering constraints

Creative Navy's Implementation Partnership for Akrivia Health involved engineering from the beginning of the engagement. Technical workshops at project start clarified performance, security, and deployment constraints so that interaction models did not conflict with architectural realities.

During build, Creative Navy remained active in the implementation process. Creative Navy answered engineering questions, adjusted patterns where edge cases appeared, and checked that the platform behaved as intended in real environments rather than only in prototype conditions.

Delivery outcomes and client-reported governance-review outcome

The Akrivia Health case separates delivery outcomes from operational outcomes. Creative Navy-recorded delivery outcomes confirm execution reliability, but they do not measure changed user performance. Creative Navy-recorded delivery outcomes were: the first interactive prototype was delivered 4 weeks after discovery completed; full interaction design and design system for alpha release were delivered within 2 months of the prototype; no deadline was missed across a 3-month engagement; and engineering implementation of core features stayed on schedule within agreed scope. The available operational outcome is client-reported. Before the redesign, governance review of cohort construction required direct involvement from the researcher who built the cohort because the logic was not independently readable from the interface. After the redesign, governance officers could follow the query structure, confirm that inclusion and exclusion criteria matched the approved study protocol, and complete review independently. This governance-review outcome is client-reported and not independently measured. It is the strongest available evidence that the design addressed the central aim of making analytical reasoning visible and auditable.

Longitudinal durability through product evolution and team turnover

Akrivia Health returned to Creative Navy approximately five years after the original engagement for a new discovery area: a dataset shopping-cart experience that helped users understand what new datasets were available and request access to them.

Across the five-year gap, Akrivia Health's own team continued developing the product with no Creative Navy involvement. This is client-reported evidence of independent evolution: the system was not only retained but actively developed by Akrivia Health's team.

By the time Akrivia Health returned, not a single person Creative Navy had worked with during the original engagement was still at the organisation. This is Creative Navy-observed evidence of durability through personnel discontinuity. The product, design system, and design principles remained after the loss of the original institutional memory of the engagement.

The later dataset shopping-cart area was built within the same product and design system, adding new components. The case evidence treats this as a within-system extension: the original design system framed the new work, although Creative Navy was brought back to build the new area.

IEC 62366-1 did not apply to the Akrivia Health engagement

IEC 62366-1 is not asserted for the Akrivia Health engagement. The Akrivia Health platform is described as medical-research software used by professionals, not as a regulated medical device.

The relevant domain constraints were NHS data governance, GDPR compliance for clinical data, pharmaceutical research governance, cohort-construction auditability, and scientific reproducibility. Creative Navy's design work treated governance constraints as design parameters rather than obstacles.

Evidence limits in the Akrivia Health case

The Akrivia Health case does not include task completion rate data, cohort construction time data, or error rate data from during or after the engagement. These would be appropriate measurements if performance benchmarking is added in future.

The delivery timeline metrics are confirmed engagement delivery facts. They do not show whether researchers built cohorts faster, whether governance review time decreased, or whether query errors were reduced.

The governance-review outcome is client-reported and not independently verified. The longitudinal evidence combines client-reported independent product evolution with Creative Navy-observed team turnover at the time of the later engagement.